There Will Never Be A Republican Replacement for the ACA, Cont’d

When congressional Republicans went off to Philadelphia for a retreat this week, they hoped to make at least some progress toward a consensus about how to proceed with repealing and replacing Obamacare.

However, secret recordings of closed-door discussions at the retreat obtained by the Washington Post’s Mike DeBonis reveal that the party remains divided, uncertain, and deeply concerned about how to move forward.

It’s long been clear that there are a great many unsettled questions regarding the legislative and policy details of the GOP’s repeal effort. These include:

How quickly should repeal go into effect?

What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?

Should Obamacare’s Medicaid expansion be repealed?

Should the rest of Medicaid be transformed into a “block grant,” program as Paul Ryan has long supported, which would almost surely mean major reductions in the number of people it serves?

Should an Obamacare repeal bill also defund Planned Parenthood?

Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?

The Post’s report reveals that every single one of these questions remains completely unsettled, and that at least some within the party have grave concerns about all of them.

Republican House members representing blue states appear to be particularly worried. Rep. Tom MacArthur of New Jersey worried about pulling “the rug out from under” people covered by Obamacare, Rep. Tom McClintock of California warned that the GOP would own “the market we’ve created … lock, stock and barrel,” and Rep. John Faso of New York said defunding Planned Parenthood in a repeal bill would mean “walking into a gigantic political trap” that could end up with “millions of people on social media” protesting repeal.

Meanwhile, Trump’s top domestic policy staffer, Andrew Bremberg, is quoted speaking in only the vaguest banalities and broadest strokes, offering no substantive guidance whatsoever besides saying that HHS Secretary nominee Tom Price is a “compassionate” guy and a good doctor.

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Does any nominally left of center person believe at this point that a Republican congress will have full-fledged and functional ACA replacement legislation ready to go when the repeal bill hits Donald’s desk? The only people I have seen are those center-right folks frantically trying to rationalize their support for the GOP while their retirement security goes up in a puff of red smoke.

jam

Does any nominally left of center person believe at this point that a Republican congress will have full-fledged and functional ACA replacement legislation ready to go when the repeal bill hits Donald’s desk?

Of course not. That doesn’t mean its excusable.

This is a good topic on which to apply political pressure. Tell them to show us the bill they support before they repeal or change anything.

upstate_cyclist

Wasn’t saying it was excusable. And the reporting on this has been top-notch from certain outfits.

I guess I was hoping to see some way that message could sink in to all those self-rationalizing conservative folks that depend on Medicare/Medicaid or the ACA for their insurance. Maybe its a fools errand and its not worth one’s time.

But damn does it make getting through the day hard when you have to listen to white male engineers prattle on with confidence that of course there is going to be a replacement for Obamacare. How could there not be?

jam

I guess I was hoping to see some way that message could sink in to all those self-rationalizing conservative folks that depend on Medicare/Medicaid or the ACA for their insurance. Maybe its a fools errand and its not worth one’s time.

It isn’t going to sink in on its own, but maybe you can push them towards recognizing that (obvious) point.

But damn does it make getting through the day hard when you have to listen to white male engineers prattle on with confidence that of course there is going to be a replacement for Obamacare. How could there not be?

Ask them which plan their favorite conservative politician supports. Don’t settle for principles or concepts, tell them they should be able to produce a white paper or preferably a bill.

If they give you something, find an analysis that shows its flaws.

If they deflect, ask them why they can’t answer that simple question.

I’ve been calling my elected officials and pushing for details on what they support and they all claim they just have no idea yet. Every time I call, I tell them that’s not good enough. It may not work but I’m going to continue.

busker type

yeah, I’ve been calling my congressman and asking to hear about his plan (which of course he doesn’t have) but it’s pretty satisfying. We absolutely have to shove their empty promises back in their face on this.

NewishLawyer

I think it would be excusable if they would be honest and say:

“We don’t think it is the job of government to provide healthcare to people.”

But they will not say this.

In some ways I think it would be interesting to have a debate and election done on strictly philosophical terms of what the nature and purpose of government is. Nozick v. Rawls perhaps. Then you will see what people really wanted from government.

Solar System Wolf

The staffer at Sen. Cory Gardner’s office did say this when my organization stopped by last week to talk about this issue.

jam

Call his office and ask them to confirm that the Senator’s position is that the ACA should be repealed without replacement.

His website says he favors a replacement. He should specify which replacement so the voters can evaluate it.

eclare

I’ve heard plenty of people say exactly this.

vic rattlehead

Excusable? Hell fucking no. If you don’t support universal healthcare, you’re an evil piece of shit and I have no respect for you.

“Tell them to show us the bill they support before they repeal or change anything.”

you’ll get that the same day Trump releases his tax returns.

rachelmap

So on the Greek Kalends, then.

BruceJ

How quickly should repeal go into effect?
What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?
Should Obamacare’s Medicaid expansion be repealed?
Should the rest of Medicaid be transformed into a “block grant,” program as Paul Ryan has long supported, which would almost surely mean major reductions in the number of people it serves?
Should an Obamacare repeal bill also defund Planned Parenthood?
Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?

In Order: No, Yes, Yes,Yes, Yes: “Get sick, go bankrupt, die quickly”

In short: “If you’re not rich, fuck off and die. ” The Republican answer to life. the universe, and everything.

vic rattlehead

If you’re not rich, fuck off and die.

The Democratic response should be “You first.”

upstate_cyclist

If only the gods were kind enough to have some notable Republican say it so completely. Or maybe more realistically, have some Democrats properly translate Ryan/Norquist weasel speak into the above.

vic rattlehead

those center-right folks frantically trying to rationalize their support for the GOP while their retirement security goes up in a puff of red smoke.

Surely socialised medicine will be just around the corner! Suck it, neolibs!

DrDick

The GOP has never had any plan other the tax cuts for the rich and big corporations and dismantling regulations impacting business.

Derelict

THIS. Getting rid of Obamacare has nothing to do with the cut-taxes/deregulation agenda. Obamacare must be eliminated because 1.) it is the prime legacy of our first (and, they hope only) Black president, 2.) it is a Democratic initiative that has helped millions of voters and thus may make a generation or two like Democrats, and 3.) it really does cut down on the amount of suffering, death, misery, and medical-debt-induced bankruptcy, so it’s worth getting rid of just on those terms alone.

Aaron Morrow

Given that Obamacare progressively raised taxes on upper class incomes and capital gains, for some people, it’s about the tax cuts.

Not that upper class jerks can’t racist, and the rest of your points sound familiar. However, I *like* having a progressive Medicare payroll tax, while Republicans don’t.

Call, twitter, and telegraph elected Republicans on this issue. Tell them to get their shit together. Write to your local newspaper and point out that they don’t have a plan. This is a political opportunity.

In the medical world we have a long list of orthopedic surgeon jokes. When one of their patients actually gets sick or has even the tiniest medical issue they immediately call people like me to fix it. They’re hardly physicians in my experience. But they make a huge amount of money, of course.

Howlin Wolfe

Feel free to share! The jokes, that is.

Joe Bob the III

When choosing a career as a doctor, if your primary goal is to make as much money as possible you become an orthopedic surgeon.

There was a somewhat recent Upshot column in the NYT that correlated medical specialty with political affiliation. Orthopedics was by far most strongly correlated with Republican party ID, with Anesthesiology a distant second.

So if you break a Nazi’s face with your fist, he’ll probably get top-notch care, at least for his fine Northern European cheekbones if not his pale white skin! Good to know.

tsam

That’s why I recommend breaking his face with 230 grains of copper jacketed lead traveling at about 900 ft/sec. That will save the poor bastard a lifetime of medical bills.

sigaba

I was working on a movie recently, a remake of a certain Kiefer Sutherland movie from the late 80s (you’ll know which one), and I was explaining to my friend that the plot was: “These med students just spend all day partying and getting wasted and then they spend all night killing each other in the basement.”

Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?

The Post’s report reveals that every single one of these questions remains completely unsettled, and that at least some within the party have grave concerns about all of them.

Really great that no one, not even his own goddamn party, has any idea what our new president wants. Definitely wonderful for our republic.

howard

i suspect that it is impossible – and i mean use that word advisedly – to sit down with trump and get him to provide a coherent viewpoint on health-care and its financing, or even a coherent set of answers to a set of multiple-choice questions.

he won’t read, he adjust all pieces of information he receives through the filter of his preconceived notions, he’s not very bright, and he certainly can’t understand the complicated tradeoffs in health-care policy: he can he tell the party what he wants?

other, of course, than it be great and cover everyone for less money.

Murc

And of course, you can easily get a plan to covers everyone for less money, if you’re prepared to violate Republican orthodoxy.

busker type

fact check:
true.

Sev

Somebody really should propose single payer to Trump- put his name on, explain that it is insurance that crosses state lines, would really be great and way better than Obama care…

Lost Left Coaster

They should just go and ask Bannon and Miller what Trump “wants.”

Because we know what Trump wants: worship, adoration, and to smite his enemies. Hard to translate that into health policy that the GOP can run on in two years.

Domino

In terms of pure curiosity – if they passed something nearly identical to the ACA, only slightly less subsidies to poor people and slightly lower taxes on the wealthy, they probably could get the Senate to vote for it.

How would their base respond? Could Trump alone convince them he struck a great deal? Going out week after week, saying how “great” and “terrific” the new law is, how many of his followers would believe him?

busker type

this is *kinda* what the Collins bill does.
It would make for substantially less coverage for middle-income folks, but it keeps the medicare expansion and doesn’t tear down the whole infrastructure of the ACA.

FlipYrWhig

I can almost guarantee that Trump thinks he can get things done politically that no one else has ever managed to do because he thinks he’ll be able to intimidate anyone who stands in the way into doing what he wants. This is what he means when he refers to “deals,” which he does all the time. What he does will be great because he made it great by being himself and doing it. Other people haven’t succeeded because they aren’t him and aren’t tough. Everyone else makes craptastic deals, but not him, because that’s what he’s mastered, getting everything he wants by barking at the other side until they give up. That’s how he sees himself and that’s how the people in his life allow him to continue to see himself.

howard

precisely right and well-put.

Joe Bob the III

Does that also explain why Trump thinks Jared Kushner is going to solve the Israeli-Palestinian conflict? Trump did say that if Kushner can’t do it then no one can.

mds

Hmm, lemme see if I remember my symbolic logic here:

If Jared Kushner can’t solve the Israeli-Palestinian conflict, no one can.

Jared Kushner can’t solve the Israeli-Palestinian conflict.

Therefore, no one can solve the Israeli-Palestinian conflict.

So, a bit of a pessimistic conclusion, but an entirely plausible one. It’s rather unlike Trump’s usual style, though.

efgoldman

Trump did say that if Kushner can’t do it then no one can.

Actually, the “no-one can” part is correct, at least as long as RWNJs are in power here and Likudniks over there.

Sev

Maybe a plan where you just stiff the doctors and hospitals?

busker type

The DOCTORS will pay YOU for your healthcare!

Domino

I mean, it would lead to the (pretty rapidly) collapse of Doctors treating people, so it definitely would be different!

The only remaining question is whether Republicans care strongly enough about inflicting large amounts of avoidable death and suffering on vulnerable people to help pay for upper-class tax cuts to take the political hit.

Is this a trick question?

We already know what the Republican ACA replacement will be. It will be modeled after the health insurance options available to the average peasant in 1600.

I think you’re assuming that the Republicans are more modern thinking than they deserve :-)

Howlin Wolfe

I, for one, welcome our new feudal overlords.

guthrie

Serf would be the better term then.

Medical history isn’t my main topic, but the medicines in 1900 weren’t much better than 1600, but people did at least have options of seeing people. I am sure in the republican utopia the peasants will have about the same ability to see a dr as the proletariat in 1900, and pay for the privilege.

JohnT

Yes – prior to about 1850 being on the ‘peasant health plan’ of no doctors, no medicines, no hospitals and just take your granny’s advice probably led to superior health outcomes.
Now, not so much

DamnYankees

It’s seriously amazing that the ACA got 60 votes in the first place when you consider how complicated it is and how many complete hacks were in the Democratic Senate caucus. Remarkable.

Taylor

Thank you, Harry Reid.

And kudos to Nancy Pelosi in the House, keeping ACA alive when people like Barney Frank were saying, Run away! Run away! after Coakley’s loss in MA.

ap77

A surprising bit of backbone shown by the Dems for once there.

Morse Code for J

And one seldom appreciated years later, even from Democrats who don’t think of the ACA as the Heritage Foundation’s plan.

Colin Day

The House passed the Senate version on the 65th anniversary of the taking of Mt. Suribachi.

Phil Perspective

Have you ever noticed the glee in which state legislatures(see Massachusetts this week) vote themselves pay raises yet refuse to handle anything remotely good benefiting their constituents at large?

What? Massachusetts has long been a corrupt cesspool of backscratching politicians WHO ALSO SPREAD THE WEALTH. Good god. Honest graft was the calling card of John Michael Curley, it’s a time-honored tradition — like the Big Dig. Good government types hated this project. It’s awesome, however. So, you are completely wrong.

Jay B

And I know it’s James. The Rascal King will haunt my dreams.

efgoldman

Have you ever noticed the glee in which state legislatures(see Massachusetts this week) vote themselves pay raises

It’s seriously amazing that the ACA got 60 votes in the first place when you consider how complicated it is and how many complete hacks were in the Democratic Senate caucus. Remarkable.

You mean like Brother Joe Lieberman?

tonycpsu

The Aetna thing is infuriating because (a) so many people knew at the time that it was a merger-related hissy fit and (b) it only worked because the ACA exchanges cannot be successful without insurance companies operating in good faith. I’m not one of those “we could have had single payer” people — the ACA was likely the best deal available — but it’s really hard to support it when a company predictably acting in its own interests and counter to the interests of the public can harm the system so much, and in this case, it likely influenced the election result. It was still worth doing because of Medicaid expansion and decreasing the number of uninsured, but boy is it hard to speak forcefully in favor of something that’s so easily weaponized against the public interest.

howard

this is why we not only want to preserve the aca, we want to improve it, by both enhancing the subsidies and by increasing the mandate penalty.

JKTH

It would have been much better if it were one national exchange instead of 51 state/DC exchanges so insurance companies couldn’t hold smaller state exchanges hostage.

howard

yes, but then we’re back to how 60 votes were gotten….

Bri2k

Aetna’s announcing they were pulling out of a bunch of ACA markets always reminded me of those old mob movies. “Nice health exchanges you have there. It’d be a shame if anything happened to them.”

e.a.foster

if the republicans repeal the ACA and people die because of it, its going to make great news and posters and with an election for Congress 2 years away, ……..This is almost a no win situation for the Republicans who are committed to getting rid of health care.

block grants can work, however, that works only if the federal government stipulates what the game rules are and loads the program with lots of money. the money is tied to the States providing what is required. its essentially what we have in Canada. The federal government stituplates and sends cash. Provinces pick up the rest. provinces all have to meet the same basic delivery of health care. Unfortunetly that won’t work in the U.S.A BECAUse of States’ rights.

Putting every one and any one on Medicaid might be the way to go and have a structured premium rate based on income.

its hard to figure out why Americans are so opposed to state funded health care. is it something in the water or how people are raised. What makes the Republicans and their supporters think its O.K. to have only the rich survive health emergencies. the U.S.A. doesn’t even have health care for its children. It blows my mind. There isn’t a “civilized” country in the world which doesn’t provide health care to its citizens and all those countries are still standing and doing well economically. Oh, well let the dying begin.

Murc

block grants can work, however, that works only if the federal government stipulates what the game rules are and loads the program with lots of money.

Of course, the whole reason Republicans are in favor of block grants is because it slowly starves the program of funding at the federal level, and allows the states to grift tons of it away at the state level.

its hard to figure out why Americans are so opposed to state funded health care.

We’re not. But in a high veto point system, coupled with a cowardly or corrupt Democratic Party, it is hard to get health care reform done.

upstate_cyclist

Why is any aspect of the social safety net in the United States not comparable to other OECD nations? Race… as it usually is. As Murc says, it’s not as if Americans don’t support the programs, its just that there are enough of them that don’t support letting “those sort of people” get access to the same benefits they themselves get.

Taylor

What makes the Republicans and their supporters think its O.K. to have only the rich survive health emergencies.

It is all about power. After Social Security was passed, Republicans spent decades in the wilderness.

The voters must not be allowed to believe that government programs can help them.

Solar System Wolf

Block grants mean the health care people get varies from state to state and isn’t tied to any notion of best practices in health care. When I was a legal aid advocate in California, the Medi-Cal adult dentistry program disappeared and reappeared randomly. This wasn’t a function of block grants per se, but because dental care wasn’t considered a core medical problem and states had the option of whether to spend their own money on it or not.

Dental care saves lives, by the way. So many politicians would say things like, “Oh, we don’t cover plastic surgery either,” like dental care was just some kind of vanity procedure. In the meantime, the only treatment for poor people with a life-threatening tooth infection was to have the tooth yanked. No denture coverage either, of course. A mouthful of missing teeth makes people so employable. People in this country used to make fun of the British for their poor dental care, while here it’s the fucking wild West.

Aaron Morrow

block grants can work … the money is tied to the States providing what is required

In the U.S., block grants specifically refer to money not tied to many rules, if any. Canadian block grants are much better, in my opinion.

its hard to figure out why Americans are so opposed to state funded health care.

Most aren’t, at least in theory. That doesn’t make getting to a public health care system any easier. Had the United States adopted a public system around the same time as Canada and many other countries (1960’s, early 1970’s – the UK started early with the NHS in 1948), it would have been so much easier. Setting up a public system was easier then because costs were much lower and the main entrenched interest to outwit or buy off were the doctors. Now the health insurance industry has to be placated.

In EU member countries, the guarantee now extends to very large numbers of non- citizens as well (i.e. those from other EU states).

anonymous

Just because there isn’t a replacement for the ACA doesn’t mean they won’t ultimately repeal it. And if they do repeal it and hurt lots of Red State Repug voters, don’t expect them to turn against the Repugs either.

White people are gonna vote for the White Party to prolong White Supremacy even if it kills them.

leftwingfox

I get the feeling they’ll be voting for it even AS it kills them .

Davis X. Machina

An increased likelihood of unnecessary suffering, sickness and death of loved ones and family members is a relatively small price to pay for the thrill of sharing in tribal victory.

Not all families will be so stricken. And the results may not be fatal. It’s all hypothetical. But the tribal victory is real.

Life’s about trade-offs. They’ve made theirs.

Mike G

If you suffer it’s because you did something bad so Jesus hates you and you deserve it.

And if it does affect them it will be all Obama’s fault. Somehow.

dogboy

The local radio this morning interviewed a representative from the Ohio Farm Bureau. They asked him what the top issues were that they would be working with the govt on. He said 1)common sense regulation of nutrients 2)common sense reform of farmland taxes and 3)Trying to keep Congress from destroying the ACA. He went on to say that a lot of farmers were finally able to get affordable insurance b/c of the ACA and that repeal could bring real harm.

This is from the representative of the people who overwhelmingly elected Trump, and all the other Republicans in Ohio’s local, state, and federal govt.

Yes, these are my people. Ohio farmers who have never been able to insure their kids. Voting Republican.

When I was 15, one of my cousins (then 12) was the only one who didn’t make it out of the fire at their farmhouse when a propane heater tipped over. He was burned over 65% of his body, and only his non-flammable PJ pants saved his life (thanks, CPSB!). Because the fire was caused by another consumer product used as directed, his parents were able to sue the manufacturer to get his medical bills paid, their house rebuilt (by my other uncle’s contracting business which charged market rates…to the insurance company) and a settlement in a trust that let the child victim open a business when he was ready to leave home.

They all vote Republican, except the gay one.

I am not making any of this up.

Jay B

Humans are astonishing.

jam

In one sense it’s ridiculous and points to woefully bad political journalism (e.g. media telling people that Trump would support single payer health care because he’s visited Europe).

On the other hand, this points to a point of weakness in the GOP coalition.

It is objectively good that Ohio farmers feel they have something to lose if the ACA goes away.

so-in-so

And objectively BAD that it didn’t influence their voting.

Maybe when health care for poor people consists of a $25 Walgreen’s gift card, the salt of the earth types will get out their signs about watering the tree of liberty and their legal fire arms and protest at GOP events. Not gonna hold my breath.

jam

Perhaps. The alternative is to tell them, plainly and loudly, that Trump, Senator Portman, and their Republican Representatives are going to take away their ACA insurance. Tell them to get mad about it and yell at Portman and their Representatives.

I’d much prefer they’d done the smart thing and voted differently 3 months ago, but I can’t change the past.

howard

my critical takeaway from the 2016 election was that despite being 63 when it occurred, i still had not fully absorbed the power of motivated reasoning: these people convinced themselves that trump understood them and he wouldn’t take away “their” benefits for no other reason than they had to convince themselves of such a thing lest their whole identity be called into question.

DamnYankees

Problem is, if liberals fight hard and save the ACA, they will have had their intuitions confirmed. They will have elected trump and not have the ACA repealed. So why not vote for him again?

They will have elected trump and not have the ACA repealed. So why not vote for him again?

Because they’re not actually attached to the ACA per se. What Erik said a while back about people “not caring about policy” is true in that most people are concerned about results, not policy. They don’t care about the details of what “plan” is in operation. They just want health care coverage they can afford.

Actually, Trump promised that he was going to replace “Obamacare” with something better, that would fix the real problems that remain with health care. But guess what? That’s not going to happen. Whatever tinkering they do will make the problems worse, not better, even if we don’t get the nightmare scenario of millions losing coverage, and the resulting mess will belong to Trump and the Republicans.

jam

That’s why my proposal is to tell the farmers who risk losing their insurance to go yell at the people they elected.

efgoldman

these people convinced themselves that trump understood them and he wouldn’t take away “their” benefits for no other reason than they….

… were white.

howard

True.

Moondog von Superman

Smaller operators, the ones who would actually need Obamacare — how do you know how they voted? I am sincerely asking for a link. (The bigger concerns, other than environmental regs their interests don’t align with Trumpism all that well (TPP, stable markets, immigrant labor) though I bet the people who run them vote for their personal tax bill above all.)

Suburban and exurban and small town non-farmers are often labeled “rural” though perhaps they should be considered differently from farmers.

upstate_cyclist

While it is good to continue to shout as loud as possible that the GOP doesn’t believe in helping people have healthcare, we should NEVER assume they will vote Democratic come election time. The latter bit being my take away from November 2016.

jam

I absolutely don’t assume that.

Maybe some of them will come around to reasonable policy and vote for a Democrat who will promote their interests.

A few more may vote for a less-extreme (whatever that means these days) Republican.

Most will go on voting for the incumbent who just tried to screw them.

But if they start yelling at their Representatives to keep their benefits rather than yelling at them to take them away that’s an improvement.

PhoenixRising

Yes. They need to go yell at their very own GOP Congresscritters, and right away. If this has the side effect of making it possible for me to buy insurance in 2018, that will be nice, but they don’t care if I die or have to live in a van down by the freeway. All they care about is themselves. And we can’t have nice things until we explain to them how *they* are going to suffer under GOP rule.

Joe Bob the III

Minnesota is proving to be an especially bad outlier in this regard, but the exchanges have turned into a real disaster for certain subsets of rural residents.

Those who buy individual policies through the exchange but whose income is too high to qualify for subsidies are getting royally screwed over by the insurance companies. If you’re unlucky enough to live in a county that is not an attractive market, e.g..: rural, you may have only one insurer selling policies. Insurers have dropped out of the market, withdrawn from some counties, and/or capped enrollment. The 2017 premium increase was over 50% in many cases. Basically, people are looking at heinously expensive premiums for plans with deductibles so high they are next to useless. The state legislature just passed a bill to provide $300 million in premium rebates to people affected.

The situation in Minnesota is the more young people than expected are choosing to pay the penalty and not buy insurance. The people who do buy are using much more care than expected. This is just an anecdote, but I heard some woman saying how great the exchanges were because she didn’t have insurance for 10 years and now she’s covered, her premium is subsidized, and she is finally getting all of her chronic health issues addressed. Well, no fucking wonder first and second year utilization rates are higher than you thought – people are entering the system with 10 years of pent up demand to catch up on.

Cheap Wino

Weren’t there rules put in place as part of the ACA that set limits on how much of a screwjob plans could be?

jam

The main mechanism there was tying the subsidy rate to the second-least-expensive Silver plan and restriction on medical loss ratio (a cap on administrative expenses and profits for insurers).

Neither of these does much to control the off-subsidy cost of insurance with an expensive population.

It also made it illegal for people to get dropped for having preexisting conditions, though. That was a major reform that alone would have made the bill a significant improvement (perhaps unless it really had been as much of a giveaway to corporations as the leftist purity trolls claimed it was).

But yeah, doesn’t do much to control costs, sadly; just means that if you’re paying for coverage, you actually (mostly) get it.

Cheap Wino

I did not realize that in the end the mechanism, of course, was profit. My bad.

mds

Well, in fairness, Trump succesfully appealed to their economic anxiety, while Clinton was dishonest and tainted with corruption. At least downticket, they voted for a senator who originally ran on support for the ACA, and who opposes its repeal.

twbb

“And if they do repeal it and hurt lots of Red State Repug voters, don’t expect them to turn against the Repugs either.”

They’re not particularly relevant. It’s the people hurt in Florida and Michigan and Pennsylvania who are relevant.

Remember, even the impression that ACA might take money away from Medicare destroyed Dems in the 2010 midterms.

Warren Terra

My understanding is that they’ve figured out a way to repeal and replace the ACA and Food Stamps at the same time, at a tremendous savings to the taxpayer. The new plan is something called “Soylent Green”. The name even suggests it might be eco-friendly!

There’s very little since Eisenhower to think that the GOP believes anything other than people should pay for healthcare out of their pocket with money they earned, inherited or grifted the old fashioned way, and if you don’t have it either too bad, or, maybe you can work something out with the doctor like volunteering to be their butler.

Nobdy

Jeez Scott, they said they were going to do tort reform for medical malpractice, after doctors are no longer forced to pay huge settlements for no reason surely competition will drive the cost way down.

After all medical malpractice costs amount to 2.4% of health care costs so once that is gone that currently unaffordable $100,000 cancer treatment will only cost a trivial $97,600. At that point the fee is so low it is basically nominal!

Cheap medicine for all.

Note that there is the tiny side effect of encouraging incompetent doctors to keep practising, which might kill one or more of your loved ones, and also if you are horribly injured by one of those incompetent doctors you won’t be able to sue for your costs, but hey, maybe they will let you arbitrate!!

Warren Terra

The great thing about “tort reform” as a health care cost control proposal is that we’ve done the experiment: some really big states have enacted quite strict caps on malpractice damages. To the surprise of pretty much no-one, it had no detectable effect on medical cost inflation.

It didn’t even affect cost of malpractice insurance as I recall, or at least not much. This is because the principal predictor of malpractice insurance premiums over time isn’t anything about medical costs, it’s the stock market. Insurance companies collect premiums and use them to pay administration and settlements, but they actually make their money (and so determine their profitability and so their premiums) by investing the money they’ve collected between receiving it and spending it.

Denverite

Comment got eaten, but said that insurance companies are usually restricted to investing 5-10% of their admitted assets in equities. They have to invest almost everything in treasuries or safe bonds.

swkellogg

That explains it. I was always looking up torte reform. Couldn’t figure out why they had a problem with pastries.

This is exactly correct. And, with repeal of the ACA, an injury to a child that will cost millions over a lifetime will result in a $300,000 award at most after legal fees. Even if they family has insurance, that old 3 million cap will come back, leaving the family on the hook for the rest.

Denverite

???

Even in the states that have caps, economic damages like future care costs are usually not included.

Didn’t they pass tort reform in Texas in the late 90s/early 2000s? I’m pretty Texas had some of the biggest health insurance cost increases in the nation during the 2000s, and I vaguely recall some “surprise” about this given their healthcare “reform”.

Warren Terra

My recollection – and I have no relevant expertise – is that both Texas and California passed something like $250k damage caps. Big, huge states. No effects relevant to the claims made by advocates.

StellaB

California’s tort reform bill was signed by Gov. Reagan. The savings should kick in any day now….

Denverite

I do have relevant expertise.

What Colorado did — and I expect Texas and California are very similar — is pass caps limiting *non-economic* damages to $250k (subsequently increased to $300k). The *non-economic* bit is pretty important. It basically capped pain and suffering (and subsequently, physical disfigurement) at $250k. It didn’t cap *economic* damages — lost income, future care, etc. So if you can get an expert to testify that you’ll need $5M in medical care for the rest of your expected life, you get it (assuming the jury believes it). If you can’t work and your future lost wages are $5M, you get it.

As for the $250k cap on non-economic damages, it’s a tough question. It certainly undercompensates plaintiffs who suffer gruesome and painful injuries at the hands of a medical provider. But a lot of juries significantly overcompensate sympathetic plaintiffs for “pain and suffering” when they’re mostly just mad at the provider. In my ideal world, there would be non-economic caps, but they’d be a lot higher than they currently are, but judges would have a LOT more discretion to reduce them to something reasonable when a jury pretty clearly oversteps its bounds.

Jordan

I think this is mostly right for Texas. The actual upshot was that suits dropped dramatically, and people who couldn’t demonstrate economic damages got completely screwed – the elderly and children, primarily – because lawyers wouldn’t take their cases anymore without the “pain and suffering” option.

catclub

What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?

No. SATSQ

Mike G

They’ve been too busy voting to repeal Obamacare 50+ times in the House of Reps. You can’t expect Repukes to actually come up with an alternative when there’s some crybaby kicking and screaming to be done.

furikawari

I had convinced myself that most/all Republicans knew there would never be a replacement plan, and the “it’s being written right now!” line was a deliberate lie. Now it seems more like their brains rejected the concept that there could be no more conservative a plan than the ACA, just as their supporters’ brains did. Or they were too lazy to learn a single god-damned thing. They are truly learning now that they are up the creek.

This makes me feel better and worse… On the one hand, perhaps they would prefer not to Kill All Grandmas. On the other, there is no 11th dimensional chess; not even checkers. The inmates are truly running the asylum.

Joe_JP

Kirsten Gillibrand ‏@SenGillibrand 8m8 minutes ago

Trump admin may not want you to know this, but Jan. 31st is the deadline to enroll in the #ACA for 2017. #GetCovered http://healthcare.gov

The basic “essential” plan in her state costs $20 a month. It is tyranny, I tell you, to require people not qualified for Medicaid or a subsidy to pay so much for health insurance. It doesn’t provide ponies!

Between the White House and the recordings of secret meetings, the unified GOP government sure is doing a good job of not be ridden with leaks.

howard

so let us ask ourselves: whose interest is being served by this administration and its putative allies in congress being so leaky?

theorizing today – while wildly inappropriate! – i would say that it’s people who would rather see pence in the oval office.

Kerans

But Pence couldn’t have won the election. This way they get him in office and a scapegoat at the same time. I mean, republicans paid for the initial russian dossier. They probably have the video and are just waiting for the right time to leak it.

Is there a “kind of sarcasm” font? I mean, I find myself typing things I know are ludicrous, yet I can no longer completely discount them.

Scott Lemieux

AFICT, the Intercept hasn’t written about these leaks, though. If only Republicans were more into risotto.

The Great God Pan

Greenwald is too busy scolding liberals for succumbing to “Boy-Cry-Wolf Syndrome” over Trump administration moves with “no facts” to back it up.

nemdam

I’m predicting a Greenwald column defending Trump lifting the Russian sanctions after he meets with Putin.

Jay B

It’s not that i’m not cynical enough, but I honestly thought for years that Greenwald — right or wrong — had exactly one principle that he would hammer over and over again, but this election has proven him to be a complete and utter hack and obviously on someone’s hook. His vaunted belief for civil liberties has evaporated into tacit support of neo-fascists who kill and jail journalists.

The Great God Pan

I think it’s possible that he does have one guiding principle: that he despises the United States government and wants to see it disempowered and humiliated to the greatest possible extent and by any possible means.

That might mean doing pro-bono work for fellow government-haters such as neo-Nazis, or it might mean assisting in the leaking of documents regarding government wrongdoing. It might also mean convincing people on the left to not vote for the only candidate who can stop a malevolent clown (and, significantly, a living caricature of everything negative about the American national character) from becoming president and wrecking the country from the inside, then helping to deflect attention away from the wreckage and anything that might ameliorate or stop it.

This topic made me think of something I hadn’t thought of, for some reason, since before the election. When I was out helping register voters for Clinton, one of the people we helped was a very frail-looking old woman who obviously didn’t have much time left and clearly knew it. I think she had a terminal cancer diagnosis; she was with a male friend of hers who was a registered Republican but strongly disliked Cheeto Benito. She, for her part, absolutely loathed Emperor Tangerine. Her primary worry at this point was living long enough to cast a ballot for Clinton, and we helped her get her info updated and get an absentee ballot sent to her house. She didn’t think she’d survive the month or whatever it was until Election Day.

I’m sure she’s already dead at this point. For some reason, I’m actually kind of comforted that she probably didn’t live to see the horrors of this administration and probably died thinking she’d contributed to helping elect the first woman president, but thinking about her makes me feel bad for all the people who are going to live out the last days of their lives in excruciating pain, watching this. (Of course, many of them probably voted for Twitler, but I do feel bad for the ones who were Clinton voters.)

AMK

I said it on the other thread, but I like my idea of them ultimately deciding that the replacement will mostly be changing the ACA funding mechanism from capital gains taxes on their donor class to some kind of sales tax mechanism that most people won’t notice, plus back-end taxes on unpopular and/or “liberal” industries. Plus maybe adding humiliating red-state medicaid-style restrictions that make people on ACA plans pee in cups or verify X hours of employment, or something along those lines. Certainly that plan would get some GOP votes.

smartone

No they want to do Obamacare without that Donor Class Revenue
This is their problem
They have to take this money and have no avenue to replace it
and are realizing that any replacement will not work without this revenue.

Imagine this visualization

Obamacare (or our Entire Healthcare system) is a Jenga tower
and that Donor Class revenue is a block right at the base the tower
Republicans have spent the last six years trying to figure out how to remove the 3.8 tax on wealthy block without the entire Jenga Tower crashing down.

It has been the Republicans turn at Jenga for 6 years and now everyone is getting a tired that their turn is taking so long.

cpinva

“The only remaining question is whether Republicans care strongly enough about inflicting large amounts of avoidable death and suffering on vulnerable people to help pay for upper-class tax cuts to take the political hit.”

yes they do, and what political hit do you realistically think they’ll take? republican voters pretty much expose their hearts, for their republican politicians to put a knife through, just as long as the GOP remains the party of white supremacy. the people that wouldn’t vote for them over this, didn’t vote for them already. so no, the GOP will suffer no political hit over repealing the ACA, unless they’re a republican in a normally blue state, and even then it will be nominal.

republicans are conceded to be evil/venal/greedy/self-absorbed pricks, whose only mission in life is to hurt the poor, and cut taxes to nothing for the rich. as long as a republican doesn’t rape a baby in the street, the media just accepts what they are as the norm.

Thursday

Ironically, part of their PR problem may be that Trump believed the Republicans when they kept saying that they had a replacement. Lord knows he wouldn’t have bothered to look at whatever plans they had, so he took them at face value and started spouting off the same phrases in public, thinking the details had already been worked out by other people.